The influence of female education on maternal health care utilization in Zambia: a multilevel analysis

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Sambo, Jairos Kepson
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University of Zambia
Introduction: In most developing countries female education is considered the single most important predictor of maternal health seeking behavior. The study seeks to analyze the role of female education by establishing whether quantitative evidence provides the same conclusions and additional neighborhood influences on maternal health seeking behavior. The study examined female education association with maternal health seeking behavior, its differences in impact and whether it is consistent across different antenatal and delivery-care services. Methods: Using the 2013-2014 Zambia Demographic and Health Survey (ZDHS) data, we specified multilevel models, to assess factors associated with (1) tetanus toxoid (TT) inoculation (2) the choice of skilled birth attendants (3) choice of skilled provider during antenatal care and (4) frequency of prenatal visits. Results: The average prenatal visits for pregnant women was 3.8. Almost 83 percent of women in the sample were immunized with tetanus toxoid, 93 percent had used some form of formal antenatal care, and 73 percent had used formal delivery assistance for the most recent child. At individual level, female education, partner’s education, household wealth, birth history are positively associated with utilization of all health services whereas household size is negatively associated. Women with secondary education had 2 times and 16 percentage point’s greater log-odds of being assisted by a skilled provider than women with no education for assisted deliveries and prenatal care respectively. There exist differences in impacts of individual-level female education and community-level education on maternal health-seeking behaviors with secondary level of education consistently being more pronounced across all health services with an exception of TT use. The proportion of educated women in the community, is positively associated with TT use and showing expected positive association on the other three maternal health services, though not significant. Community education had a 1.4 times greater log-odds effect on TT use. At community level, region and place of residence are positively associated with the use of all maternal health services. However, the results show that both individual and community level factors have a much stronger effect in the rural sample. Conclusion: The results suggest simultaneous targeting of health policy at both individual and community-levels. Efforts by the government should be targeted to provide universal secondary education in rural and hard-to-reach communities coupled with reducing provincial and regional disparities in the provision of maternal health services.
Master Arts in Economics
Women's Health. , Women--Education